Provider Demographics
NPI:1154384774
Name:GROSSMAN, MARTIN A (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 W PALMETTO PARK RD STE 15-847
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:917-202-9070
Mailing Address - Fax:
Practice Address - Street 1:7050 W PALMETTO PARK RD STE 15-847
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3426
Practice Address - Country:US
Practice Address - Phone:917-202-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.145785207RH0002X, 207PH0002X
MO2022044819207RH0002X
NY199759207RH0002X
NJ25MA11014800207RH0002X
IAMD50899207RH0002X
GA92236207RH0002X
FLME144803207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113557300Medicaid
MO830118965Medicaid
OH00006646Medicaid